HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABL INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED q
Date:I Permit Number: `r a✓ d� 1
RECEIVED
WN-10
OCT 12018
:'' Buildirir.g Permit Application
Planning and Development Services ST. Lucie County, Permitting
Building and Code Regulation. Division
2300 Vir inia Avenue:Fort Pierce FL 34982...
Phone: (772) 462-1553 Fax: (772) 462-1578 COrY merClal Residential:
PERM ITIAP.PLICATION FOR: :Shed DCA SCANNED
. .. 0L LuVle UUunry
Address: �►�Ic:D i��
Legal Description:
Property Tax ID:#: 071ro,00 Lot No.�_
Site :Plan Name*. - Block No.
Project Name:
Setbacks. Front ...Back: Right Side: Left Side:
N�,VI`YIV:7•I61AVl'i'Id1�C.J1Y �%IIVtfVIAIYrlll l,Il"Ji1Y p��,� ua Vi v� /", ,,.,, ,:r ipi, /„""." , a" 't'-= _ .
Additional) work to be ertormed: under this'permit - check all apply:
HVAC Gas Tank :: Gas Piping :Shutters. a Windows/Doors
—. .
Electric Plumbin Sprinklers Generator Roof Roof itch
Plumbing `I p.. � P
Total Sq: Ft of Construction:. S f1 ®:. S .:Ft. of First:Floor:
m
1 Sewe Cost of Conrng Height:-
- struction:. $ G,� ® Utilities: Septic Buildi
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:OWNER/L�EySSEE� F, ,, a heir,,�{���C��, �i , �,�
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Name. ,.. ...
Name:..
Address.:. ,, ��
Company: ... .
City: .: State: l.-
Address:
City: State:
Zip Code: Fax:
Phone No. 4- >
Zip Code: Fax:
Phone No.
E-IV ail:
E-Mail:
Fill in fee simple Title Holder rn next: page ( if difference
State or County License:
from the Owner listed above)
If value of constructioh:is $2500 or:more, a RECORDED: Notice of Commencement is required:
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SUPPLEMENTAL CONSTRUCTION,LIEN LAW INFORMATION
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DESIGNER/ENGINEER: —
Not Applicable
MORTGAGE COMPANY:
_ Not Applicable
Name:
Name:
Address:
Address:
City:
State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _
Not Applicable
BONDING COMPANY:
Not Applicable
Name: �
Name:
Address:
Address:
City:
City:
Zip: Phone:
i
Zip: Phone:
OWNER/'ICONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
comme"ing work or recgZding your Notice of Commencement.
re of Owne""r/Xes;eQContactor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA' STATE OF FLORIDA
COUNTY OF 1:D;c,-\ \)r- - COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was ac owledged before me
this day of OC+0 bef 201by this _day of 20_ by
Name of person making statement Name of pers making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identifica n
Produced Produced
DA ��..
(Signature of Notary Public05tate of
No. 2-5b1 &
REVIEWS I FRONT ZONING
COUNTER REVIEW
•o• p.N SG,
.• •-aOTAy�S
::MY Comm. explres
March 05, 201g
alf GG25671g
SUPERVIS
REVIEW
fdre of Notary Public- State of Florida )
ission No. (Seal)
DATE I
RECEIVED,
DATE
COMPLETED (q I,-e
Rev. 8/2/17
VEGETATION I SEA TURTLE I MANGROVE
REVIEW REVIEW REVIEW